The value of 'organizational intelligence': How 2 health systems are keeping experienced workers engaged

Hospitals and health systems nationwide are experiencing increased workforce challenges and staffing shortages, making it more crucial than ever that they engage with experienced employees and ensure they are content in their job.

This can be a difficult task given that many workers, both newer and experienced, are leaving their hospital roles or healthcare altogether for various reasons, including retirement, burnout and other opportunities. The American Association of Critical-Care Nurses' October survey of 9,355 nurses found 67 percent of nurses plan to leave their current position within three years.

As a result, organizations are getting creative and implementing a variety of initiatives to not only retain experienced workers but ensure they contribute to the organization after they leave their full-time position.

Becker's Hospital Review caught up with David Gill, PhD, vice president of team member culture and experience at New Hyde Park, N.Y.-based Northwell Health, and Claire Zangerle, DNP, RN, chief nurse executive of Pittsburgh-based Allegheny Health Network, to discuss the need to retain experienced workers and how their organizations are supporting those workers.

Staying connected to experienced workers

New Hyde Park, N.Y.-based Northwell Health is the largest health system in New York with more than 20 hospitals and more than 80,000 employees.

This year, the health system launched an alumni relations department, which aims to stay connected with former employees.

"That particular department is focused on keeping our team members who have left our organization, whether due to a move to another company, relocation or retirement, connected to Northwell. We'll maintain communication with them and offer them a special and differentiated experience, while allowing us to better maintain the organizational intelligence that they've gained through their time working with us" said Dr. Gill, PhD.

Dr. Gill said this alumni population can help with brand ambassadorship, new hire training, mentoring programs and coaching, and philanthropy, in addition to serving as a referral network for other hires.

Northwell is also focused on programs geared toward its former leaders, including nursing executives and other individuals who have experience at the bedside as well as a leadership perspective.

Through Northwell's staffing agency, FlexStaff, the leaders will fill roles internally in Northwell's different business units, based on the knowledge, education and experience they currently have. The initiative is known as ExecStaff.

"That's another program where we're leveraging individuals who may have left the organization and have a greater variety and depth of experience," Dr. Gill said. "We have a good understanding that our nurses — and many other nurses in healthcare environments — chose nursing to make a difference and because of a greater purpose: a purpose to serve and provide clinical care. How we try and maintain that connectivity is by building programs, with their voice and contributions included."

He said that means experienced nurses as well as more junior nurses can participate in collaborative care councils at Northwell locations, to help solve problems that directly affect their work. That might include a tactic that can be implemented locally, to make their experience better.

Dr. Gill said all of the programs — whether it is the alumni program, working with FlexStaff's executive staff division or having older nurses serve as mentors and coaches to help newly hired nurses — are geared toward elevating experience in the workforce. This is something healthcare leaders view as especially crucial given that the U.S. could see a deficit of up to 450,000 registered nurses available for direct patient care by 2025. At Northwell, 250 to 300 new team members join the organization weekly, including approximately 35 new nurses.

And while the health system sees hiring and retention as a continued growth area, "if the knowledge that our nurses gained through their experience within our organization can continue to be spread to nurses who remain, I think that's where we'll have a competitive advantage," Dr. Gill said.

Once workers are sharing their experience, Northwell has initiatives to help keep experienced workers happy at their workplaces. One such initiative is focused on helping workers across generations who have caregiving responsibilities.

"A team member may have responsibility for an adult or minor outside of work. So, we do have programs in place to support people through those caregiving challenges. And those programs help relieve a lot of the stress associated with being outside of the home," said Dr. Gill.

Keeping experienced workers happy

He also said Northwell focuses on ensuring nurses and other workers feel appreciated for their work through awards and other means, and that they have opportunities for growth, regardless of where they may be careerwise.

"Whether it is growth in a skill, or even the opportunities to teach others, that remains to be one of our key offerings, providing an opportunity to grow and thrive here at Northwell," Dr. Gill said.  

Dr. Zangerle, of Allegheny Health Network, said ensuring retainment of experienced nurses is especially a focus for Allegheny amid shortages of nurses in the acute care setting.

"It is very difficult work. It's physically demanding. It's mentally demanding. It's emotionally exhausting. But the bedside, direct care nurse, that practice of nursing is so valuable and so needed. And, of course, that's where we have the biggest shortage," Dr. Zangerle said. "So, as our workforce is aging — and it is — what are we doing to keep those nurses with that amazing knowledge, capital, in direct care positions?"

One factor many health systems have considered is compensation. During the pandemic, organizations offered employees bonuses and pay increases as part of their recruitment and retention efforts. Allegheny is no exception. Most recently, in March, the health system announced it would invest more than $92 million in pay increases and benefits.

"We have done wage adjustments to match and sometimes exceed the market. And even in this very dynamic compensation market, we've done that. We've [also] enhanced our benefits. And these are all tangible types of things," said Dr. Zangerle.

Competitive pay, on-site day care, housing and tuition reimbursement/assistance programs, and even covering employees' gas costs to get to work are among monetary incentives that will likely continue. However, hospitals and health systems have also offered workers more flexibility in when and where they work. 

Take Allegheny, which has offered experienced workers incentives for picking up extra shifts, for example. The program allowed workers to add an additional shift a week over several months in exchange for overtime pay and a bonus for the extra shifts. The health system continues to consider flexible scheduling options.

"We worked really hard to listen to our nurses [and asked], 'What's important to you?' [They said], 'What's important to me is being able to set my own schedule, and if I don't want to work a weekend, I don't have to work a weekend. If there's an opportunity, because of my seniority, to not work weekends, then I want to be able to do that. Or if I only want to work weekends, and not during the week, will you compensate me at a higher rate, because I'm getting up every single weekend?'" Dr. Zangerle said.

Additionally, she said Allegheny has created hybrid positions where nurses who typically have worked solely in direct care can spend some of their time in an indirect care role, like as a research nurse or teaching in nursing schools associated with Allegheny's hospitals.

She said this gives the nurses "the best of both worlds."

"We've created those positions, and people really do like those. Because I can tell you, we are competing with these work-from-home nursing jobs, which are killing us," said Dr. Zangerle. "It's great for nurses who need a break. They sit at home, they do case management on the phone, or that type of thing. And that knowledge capital there is great, too, but it's causing a lot of problems for us as we're trying to keep nurses in direct care."

Currently, Allegheny has about 3,000 acute care nursing positions, of which 800 are open.

Dr. Zangerle's message to other healthcare executives: "We're trying to manage our staff expectations and manage our staff's resilience and stress. And the best thing that executives could do is be present and continue to listen to staff and communicate with staff about their struggles and how we're meeting those struggles and challenges."


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